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National Household Survey Capability Programme. The role of the NHSCP in providing health information in developing countries.
New York, New York, United Nations, 1983. iv, 47 p. (NHSCP Technical Study No. 3; DP/UN/INT-81-041/3)The objective was to clarify and strengthen the role of household surveys in the context of the UN National Household Survey Capability Program (NHSCP) as instruments for providing health information. Under the concept of Health for All by the year 2000, the NHSCP is valuable for developing countries in the systematic process of health care planning and management. The NHSCP contains an integrated, institutionalized, and population-based approach to social and economic statistics. Thus, the NHSCP supports the Health 2000 philosophy and primary health care strategy, which associates the causes of ill-health with inadequate nutrition, water and sanitation, housing, education, and income. The NHSCP pools information to make more effective use of statistical resources; provides estimates whereby it assists planners and policy makers; and encourages countries to establish regular surveys. In data collection it is vital to have coordination between health ministries and central statistical offices to recognize the priorities of health statistics, and in the analysis and dissemination of health-related survey data. Data which are not available from health care system records are gathered: 1) social, demographic, and economic characteristics (family size, education, occupation, and income); 2) factors bearing on living conditions such as drinking water, sanitation, and nutrition; 3) estimates of fertility and mortality; 4) extent and severity of acute illness and disability; 5) use or non-use of the health care system and other health care measures; and 6) knowledge and attitudes concerning health status. The principal beneficiaries of these data are managers and planners in the health sector. These benefits, however, are limited, as national sample surveys cannot provide disaggregated data for planning at the community level, nor can they aid the job of primary care workers. Household surveys have difficulty in identifying specific diseases and causes of mortality. On the other hand, household surveys will provide essential health statistics for monitoring of progress towards Health 2000.
Washington, D.C, Pan American Health Organization, 1983. x, 145 p. (Scientific Publication No. 435)This document, prepared by the Pan American Health Organization (PAHO), reviews health in the Americas in the period 1905-47, provides a more detailed assessment of progress in the health sector during the 1970s, and then outlines prospects for the period 1980-2000 in terms of meeting the goal of health for all by the year 2000. The main feature of this goal is its comprehensiveness. Health is no longer viewed as a matter of disease, but as a social outcome of national development. Attainment of this goal demands far-reaching socioeconomic changes, as well as revision of the concepts underlying national health systems. It seems likely that the coming period in Latin America and the Caribbean will be characterized by intense urban concentration and rapid industrialization, with a trend toward increasing heterogeneity. If current development trends continue, the gap in living standards between urban and rural areas will widen due to sharp differences in productivity. Regionally based development planning could raise living standards and reduce inequalities. In the type of development expected, the role of social services is essential. It will be necessary to determine whether the objective is to provide the poor with access to services that are to be available to all or to provide special services for target groups. The primary health care strategy must be applicable to the entire population, not just a limited program to meet the minimal needs of the extreme poor. Pressing issues regarding health services in the next 2 decades include how to extend their coverage, increase and strengthen their operating capacity, improve their planning and evaluation, increase their efficiency, and improve their information systems. Governments and ministries must be part of effective infrastructures in which finance, intersectoral linkages, community participation, and intercountry and hemispheric cooperation have adequate roles. One of PAHO's key activities must be systematic monitoring and evaluation of strategies and plans of action for attaining health for all.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., AID, International Center for Diarrhoeal Disease Research, Bangladesh [ICDDR/B], United Nations Children's Fund [UNICEF], and the World Health Organization [WHO], 1983. 156-9. (International Conference on Oral Rehydration Therapy, 1983, proceedings)In 1969 the World Health Organization (WHO) arranged for trials of oral rehydration salts (ORS) production. The formula that was developed contained the following basic ingredients per liter of water: 20.0 grams of glucose anhydrous, 3.5 grams of sodium chloride, 2.5 grams of sodium bicarbonate and 1.5 grams of potassium chloride. As the product has become more widely used, a problem with its stability has been discovered, due to the interaction of glucose and sodium hydrogen carbonate. The stability problem was solved in some developing countries by packing glucose or bicarbonate separately, but the solution was not feasible in some countries due to a lack of necessary facilities or funds to maintain them. Based on WHO initiated testing, trisodium citrate offered the best prospects as a substitute for bicarbonate. It should be noted that the present ORS formulation is not discredited by the citrate alteration. If the bicarbonate formula is to be produced it should be packaged in a number of ways including aluminum foil, polyethylene bags, or 2 separate bags, depending upon where or when they will be distributed. The citrate formula should be packaged in aluminum foil, polyethylene bags, or paper/polyethylene laminations, depending upon use. Choice of formula and packing material depends also on the quantity to be produced. Small amounts of ORS can be prepared in hospital pharmacies for in and outpatients. Quantities of more than 2 million packets per year are easier to fill with semiautomatic equipment. Quantities of 4 million or more are more conveniently filled with an automatic machine. In most cases locally produced ORS is no less expensive than imported packets, but they offer advantages like the ability to respond immediately in an emergency and freedom to choose a dosage that is adapted to a standard size container for the country. Flexibility to produce ORS according to local needs and the principle of self reliance are also important advantages of locally produced ORS.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 8-13. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The worst economic setbacks since the 1930s do not augur well for the 100s and millions of children already trapped in the day-to-day silent emergency resulting from the conjunction of extreme poverty and underdevelopment which contributes so greatly to the death and disability toll which afflict over 40,000 small children per day. In the absence of special measures to accelerate health progress significantly, millions more children and mothers in low income areas are likely to die in the decade ahead. This meeting on promoting oral rehydration therapy is a concrete reminder that the key to the effectiveness in improving children's conditions is a refusal to accept a limitation upon what can be done with the available resources. In September, 1982, UNICEF invited a group of experts drawn from international agencies and nongovernmental groups involved in improving the lives of children to meet and discuss the problem. They recognized that certain elements of the primary health care strategy, including oral rehydration therapy, could greatly contribute to the realization of the health for all goal. They focused on community-based services and primary health care and how to improve health services. The improved techniques and technologies, the increased acceptance of the primary health care approach, and a new capacity of social organization for reaching low-income families could save a high proportion of children's lives. Nutritional surveillance, oral rehydration, breastfeeding and better weaning practices, immunization, family spacing, food supplements, and health education will contribute to the health of millions of mothers and families. Everyone is urged to make a commitment to strive for the health for all goal. The media, private organizations and ministeries of health must all join in the effort.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2, Background documents.
Copenhagen, Denmark, Scriptor, 1983. 2 986 p.Volume 2 of papers from an international symposium starts with chapter 7--available methods of fertility regulation; problems encountered in family planning programs of developing countries. Natural family planning is discussed here, as well as contraceptives and male and female sterilization. Chapter 8 covers research problems with regard to epidemiological, service, and psychosocial aspects of fertility regulation. Family planning is stressed in this chapter. Chapter 9 discusses future methods of fertility regulation: progress in selected areas. New contraceptive agents are discussed, such as luteinizing hormone releasing hormone and its analogues, gossypol for men, and immunological methods of fertility regulation. Chapter 10 also discusses future methods of fertility regulation, but from the point of view of research needs and priorities as viewed by program directors and advisers. Views and research priorities of the Population Council, and the Indian Council of Medical Research are given. Research needs and priorities in China are discussed, as is the role of the World Health Organization's Special Program of Reseach, Development and Reserch Training in Human Reproduction. Lastly, chapter 11 covers the role of governments, agencies and industry in reseach on fertility regulation. The role of the Agency for International Development, the US National Institutes of Health; and the World Bank, among others, are discussed.
In: United States. Food and Drug Administration. Depo-Provera Public Board of Inquiry. Official transcript of proceedings, Food and Drug Administration. Depo-Provera Board of Inquiry. Vol. 3. January 12, 1983. Arlington, Virginia, TIW Reporting Group, . 40-55.In this testimony to the US Food and Drug Administration (FDA) Deop-Provera Public Board of Inquiry, Pramila Senanayake, Medical Director of the International Planned Parenthood Federation (IPPF), urges the FDA to reconsider its decision not to approve Depo-Provera for use in the US. It is noted that over 15 years of clinical experience with Depo-Provera has demonstrated that the drug represents a safe and effective method of fertility regulation. Over 11 million women worldwide have used Depo-Provera and more than 2 million women are currently using it. IPPF has estimated that the drug is significantly available in 10 of the 14 developed countries where it is licensed for contraceptive use. Depo-Provera represents an attractive option for women in need of highly effective contraception but who have difficulty complying with the daily routine required by oral contraception or who cannot tolerate the IUD. Since Depo-Provera contains only a long-acting progestogen, it does not involve the side effects related to estrogen. Moveover, it represents a safe contraceptive choice for women over 35 years of age who smoke. Approval of Depo-Provera for longterm contraceptive use would increase the options open to users and physicians, enhancing the possibility of meeting the specific contraceptive needs of a greater number of couples. If the US reaffirms its decision not to approve the use of Depo-Provera for contraceptive purposes, there is the danger that many other countries will feel compelled to take similar action, depriving women in these countries of access to this method.
In: United States. Food and Drug Administration. Depo-Provera Public Board of Inquiry. Official transcript of proceedings, Food and Drug Administration. Depo-Provera Board of Inquiry. Vol. 3. January 12, 1983. Arlington, Virginia, TIW Reporting Group, . 7-13.Dr. S. Holck, a member of the World Health Organization (WHO) Secretariat, described WHO's Special Program of Research and Human Reproduction and introduced the representative of the program who will address specific questions raised by the board in this inquiry. The program was eastblished in 1972 for the purpose of promoting family planning research and development. 1 area of research which the program focuses on is assessing the safety and effectiveness of existing contraceptives. The program helps developing countries conduct large scale studies through a network of WHO centers. The use of the same protocal for collecting inforamtion in all centers facilitates interpopulation comparison ans ensures that data is collected on large population samples. The safety of Depo-Provera has been assessed by the program on a continuing bases. In 1978 the program convened a meeting of its Toxicology Review Panel, scientist, and members of drug regulatory agencies to examine the findings of animal and human studies in the 2 currently available injectable contraceptives. i.e., Depo-Provera and norethisndrone enanthate. The members concluded that the findings did not substantiate that there were serious associated with Depo-Provera for humans; however, they noted that there was a need to continue monitoring Depo-Provera in order to assess whether prolonged use of the drug produced serious adverse affects. In 1981 the program convened another meeting to assess injectable contraceptives in light of the findings of more recent animal and human studies. The participants saw no reason to reverse their earlier decision regarding Depo-Provera. Depo-Provera has been used for 15 years and there is no evidence that the drud is associated eith any more adverse than other hormonal contraceptives. The program is continuing to conduct extensive research on injectable contraceptives. Studies include: 1) phase 3 and phase 4 clinic trial; 2) a large comparative study of the 2 injectables; 3) a case control study of neoplasia and steroid contraceptives, including Depo-Provera; 4) an investigation of the effects of Depo-Provera on exposed infants; 5) several investigations to identify any longterm effects of Depo-Provera; and 6) several studies on the drug's metabolic, lipid and protein effects and pharmocology.
In: Shirley O, ed. A cry for health. Poverty and disability in the Third World. Frome, England, Third World Group for Disabled People, 1983. 73-8.Disability in developing countries is largely a social, political and economic disease, a symptom of underlying conditions of great injustice and inequality. The author asks to what extent do the multinational corporations (MNCs) sustain poverty and disability in developing countries. MNCs usually operate within environments where the emphasis in national development and growth is overwhelmingly on the security and prosperity of the relatively welathy minority. There is no international supervision over MNCs at all and control within the developing country tends to be weak since home governments have a vested interest in earning foreign exchange. Also, MNCs are extremely effective in making and marketing goods and in persuading people that these goods bring advantage to them. The multinational pharmaceutical industry represents concentrated capacity and wealth; just 10 companies control 25% of the world's total drug production while the top 110 companies control 90% of the total. By contrast, the average developing country represents concentrated incapacity and ill-health. There is distortion of national health priorities in many developing countries in that most of the drugs which are bought and sold are not essential. In addition, multinational drug companies usually observe lower standards in developing countries than elsewhere. An example is provided of the sale of Lomotil to control diarrhea in developing countries by G.D. Searle, a pharmaceutical manufacturer. Lomotil is an anti-diarrheal drug; it doesn't treat the condition that caused the diarrhea in the 1st place. It was found by the World Health Organization that this drug was not appropriate for the type of diarrhea found in developing countries, and a leaflet was produced by the US Food and Drug Administration to that effect.
Steroids. 1983 Mar; 41(3):243-53.The great demand for improved longacting injectabe steroid contraceptives, particularly in developing countries, and the relative lack of interest from the pharmaceutical industry to develop such products stimulated the World Health Organization to launch a synthetic and screening program to find improved, safe, and acceptable injectable preparations. More than 210 esters of norethisterone (17alpha-ethynyl-17beta-hydroxyestr-4-en-3-one) and levonorgestrel (D-(-)-13beta-ethyl-17alpha-ethynyl-17beta-hydroxygon-4-en-3-one) have been prepared in university-based research laboratories situated mainly in developing countries, and then screened by NICHHD in animal models. The following 3 compounds levonorgestrel butanoate, cyclopropylcarboxylate, and cyclobutylcarboxylate, proved to be particularly longacting when administered as microcrystalline suspensions. The overall strategy of this research and development program is described. (author's modified)
Washington, D.C., World Federation of Public Health Associations [WFPHA], 1983 May. 24 p. (Information for Action Resource Guide)This action resource guide is intended to support field staff in the implementation of large-scale oral rehydration therapy (ORT) programs. It was prepared in response to interest expressed by health and program staff in obtaining current information on technical and delivery issues. The guide takes the form of an annotated bibliography of project studies and journal articles covering the areas of ORT overviews, ORT programs (effectiveness, delivery, and education), and technical issues (contamination of solution, ingredients, nutrition and diarrhea). Additional sections describe training manuals, teaching aids, research institutes, and relevant journals and bibliographies. The sources selected for annotation represent only a small portion of the available literature; however, a list of additional readings is included at the end of each section. The documents cited are current, generally available in English, and oriented to nontechnical field staff.
Journal of Tropical Pediatrics. 1983 Dec; 29(6):325-9.Research conducted by the United Nations Children's Fund (UNICEF), in the mid 70's on child nutrition in the Gulf Arab States revealed that in spite of fast growth in volume and funding of children's programs, no qualitative improvement in the conditions of children has occurred. In a study of a sample of 3258 children below the age of 6, 1/3 were found to be suffering from some form of malnutrition. While primary malnutrition is predominant in the Gulf countries, secondary malnutrition is much more frequent. The main causes of secondary malnutrition are: parasitic infestations, diarrheal disease, and malaria. The findings of the field research as well as the conclusions of local and regional meetings, workshops and seminars organized to deal with children's problems were of great value in: shaping training programs; selection of consultants; organization of seminars; building demonstration models; developing evaluation surveys; producting of material for a comprehensive education project in health, nutrition and personal safety; as well as developing campaigns of advocacy for the children. 28 specific research activities undertaken by UNICEF between 1980-1983 are listed. In addition, the impact of UNICEF on developmental planning and decision making in the Gulf is evaluated for the local and regional levels. It is still too early to assess the impact of the actions and projects implemented by UNICEF, however early indicators reveal a significant improvement in the area of child nutrition.
Indian Pediatrics. 1983 Apr; 20(4):235-42.This article discusses implementation of the Alma Ata Declaration on primary health care in developing countries, particularly in India. Tasks are outlined in the areas of health indicators, training of health personnel, allocation of resources, integration of traditional health workers, drug policy, and health delivery strategies. The success of the primary health care strategy hinges on the support of the rest of the health system and of other social and economic sectors. Each country will have to specify its own health goals and priorities within the context of overall development policies, particular circumstances, social and economic structures, and political and administrative mechanisms. The training of health personnel, which is an essential part of primary health care, should be geared to the health needs of the community rather than patterned after the health services in developed countries. In particular, greater use should be made of community health workers. Traditional practitioners represent another potential reservoir of personnel for primary health care, and their integration into the modern system of medicine should be organized. The Government of India has adopted a strategy aimed at integrating promotive, preventive, and curative aspects of health care through a decentralized approach that involves the community in planning, providing, and maintaining the health services. 580,000 community health volunteers, as well as 1 traditional birth attendant for each village, are scheduled to be trained. A subcenter with 1 male and 1 female multipurpose worker is planned for every 5000 population; a subsidiary health center staffed by a doctor, 2 health assistants, and 2 multipurpose workers is proposed for every 25,000 population; and a primary health center is proposed for every 50,000 population, with 1 in every 4 centers to be upgraded to a rural hospital. The Integrated Child Development Services (ICDS) program delivers maternal and child health services at the village level. The number of ICDS projects is proposed to be increased to cover 913 of the 5011 community blocks and 87 urban slum areas by 1985.
In: United Nations. Department of International Economic and Social Affairs. Population and Human Rights. New York, United Nations, 1983. 188-201.Conclusions of the 1974 Symposium on Population and Human Rights deal with the most important problems of the relationship between human rights and population policies. Attention is directed to those conclusions that are of particular relevance to the subject as they constitute the basis for this present review of elements in the approach to human rights and population. The 1st Symposium on Population and Human Rights had a major impact on the World Population Plan of Action adopted by the UN World Population Conference held in 1974. The subject of human rights and population policy must be approached juridicially bearing in mind the domestic law of each State that has the sovereign right, in principle, to legislate thereon, yet, at the same time, consideration must be given to the relevant international norms. In considering population and human rights problems, the subject of development, part of the general agenda of the new international economic order, must be included as a collective and as an individual right. The right to life and the right to couples and all individuals to decide freely and responsibly the number and spacing of their children are explained and take on their full meaning in the context of the right of every human being to full development of his or her personality. There currently exists, at the international level, a contractual system for the protection of human rights with a system of procedures for assigning responsibility for this protection to the Human Rights Committee, which, with respect to the States Parties, has the respective powers conferred on it by the International Covenant on Civil and Political Rights and its Option Protocol. These human rights instruments are not the only ones in the purview of the UN which are connected with population problems. Other instruments, with particular relevance to this subject, include: the Convention on the Prevention and Punishment of the Crime of Genocide; Convention on Consent to Marriage, Minimum Age for Marriage, and Registration of Marriages; International Convention on the Elimination of 11 Forms of Racial Discrimination; and Convention for the Suppression of the Traffic in Persons and of the Exploitation of the Prostitution of Others. Since 1974 there has been a substantial increase in the number of State Parties to the identified Conventions and a start has been made in formulating a convention on the rights of the child. Also much progress has been made at the regional international level and this is reviewed.
British Journal of Sexual Medicine. 1983 Jun; 10(97):27-32.Population education, including family life responsibility and some discrete sexual education, has been introduced for the 1st time in China to selected senior high school students in the 1981-82 academic year. The course covers units on Marxist population theory and the dynamics of population growth from a national and international perspective. Emphasis is placed on the interrelationship of China's 4 modernization programs and the basics of birth control. Particular emphasis is on the promotion of the 1-child family concept and the improvement of population quality through eugenic control. The new course is designed specifically for adolescents and is intended to lay the groundwork for acceptable social sexual behavior for senior high school students (16-17 years of age). The UN Fund for Population Activities (UNFPA) has contributed significantly during the past 2 years to the development of population studies and demographic research within China. It has assisted with research, computer studies, and personnel training for the 1982 census. It also has trained demographers and assisted in the establishment of new population institutes at 10 key universities in various parts of China. The UNFPA program for high schools has earmarked funds for the training of some 8000 teachers in a series of month long workshops, 10 day orientation courses for administrators, the development of modern audiovisual facilities, and reference materials for 10 teacher training institutes, the production of instructional materials for 10 key or pilot middle school programs, and the development of a revised middle school curriculum in such fields as biology, geography, hygiene, physiology, and political study. The new text book, "Population Education," explores openly the many familial problems which will confront China's children in the future. The text rigorously promotes the 1 child family concept as the social and national ideal. The book includes straightforward information on human sexual reproduction and contraceptive knowledge which was previously unavailable in such detail in other Chinese secondary text books. The section on birth control principles is factual and makes no attempt to moralize. The prevention of pregnancy is discussed without reference to marriage, although in China it is tacitly understood that sexual relations should be fostered only within the bonds of marriage. Another section of the book includes a section devoted to the significance of marriage. Another section of the book includes a section devoted to the significance of eugenics. The book is written from a contemporary demographic and political perspective.
Geneva, Switzerland, World Federation of Public Health Associations, 1983 Jul. 20 p. (Information for Action Resource Guide)Women in developing countries have special nutritional needs because of the tremendous physical burdens they bear in daily tasks, pregnancy, and lactation. Poverty and custom often cause these needs to go unmet. Poor maternal nutrition affects not only the mother's health, but also that of her children. While some elements of maternal nutrition are well known, discussion and experimentation continue on important nutritional and delivery issues. This Resource Guide, aimed at field staff who are not nutritionists, summarizes recent literature on this important topic. The annotations discuss both the causes and effects of maternal undernutrition. They also describe simple monitoring techniques to gauge maternal nutrition status and short-term programmatic interventions such as food fortification, food supplementation, vitamin distribution, and health education. The documents chosen synthesize important issues and experiences. The documents included are highly selective; some important literature and projects are not mentioned as this guide is mainly designed for busy program officials. Readers are encouraged to consult the references cited thorughout the guide for in-depth studies. Non-technical language is used throughout the text to facilitate understanding of the main concepts and issues.
New England Journal of Medicine. 1983 Fall; 61(4):659-86.In this examination of Saudi Arabia's health care accomplishments, it is argued that the World Health Organization's primary health care model is not the most appropriate for Saudi Arabia and countries like it. Saudi Arabia's health care policy is closely linked to its very rapid emergence as a new and distinctive society. Whereas most developing countries export physicians, Saudi Arabia imports them because the demand for physicians services cannot be met by the supply of indigenous physicians. Saudi health care development is very different from that of most of the third world. Although the country does have a great deal of western technology, Saudi Arabia seems to be following a different course of development from both the third world and the West. Unlike the West, the cost of medial technolgoy is not a problem for Saudi Arabia. Rather, it solves the problem of how to allocate its oil wealth to maintain political stability. The Saudis intend to make the best health care available to all its citizens; they are very concerned about the effect of modern technology on tradition. Therefore, the selection of technology is based on its cultural compatability, rather than on its costs. Primary care may be more technological and specialized than in the West. In Saudi Arabia primary health care may eventually be delivered entirely by specialists, rather than by general or family practitioners. The Saudis are expected to develop a health care system that will meet their particular needs. As with Saudi Arabia itself, health care is experiencing unprecedented change. Thus, the emerging Saudi system will be unique and innovative. Some of its accomplishments will be adopted by other developing countries; Western countries may look to Saudi Arabia as a natural laboratory of health care experimentation.
Washington, D.C., World Bank, 1983 Jan. 140 p. (World Bank Staff Working Papers No. 526)The relationship between women's economic participation and their input into household decision making was investigated in 7 village studies in Nepal. 2 distinct cultural traditions were represented in the sample: Indo-Aryan/Hindu and Tibeto-Burman/Buddhist-Animist. The village economy is conceptualized in 4 concentric spheres: 1) household domestic work, 2) household agricultural production activity, 3) work in the local market economy, and 4) employment in the wider economy beyond the village. Aggregate data revealed that women are responsible for 86%, 57%, 38%, and 25% of the input into these 4 spheres, respectively. It was hypothesized that women's participation in the market economy increases their status (defined in terms of household decision making), while confinement to nonmarket subsistence production and domestic work reduces women's status. This hypothesis was confirmed. Women in the more orthodox Hindu communities, who are largely confined to domestic and subsistence production, were found to play a less significant role in major household economic decisions than women in Tibeto-Burman communities where women participate more actively in the market sector. Money earned in the market sector allows women to make a measurable contribution to household income, and thus appears to enhance the perception of women as equal partners. In addition, women's decision making input was found to be inversely related to the income status of the household. These results indicate that integrating women into the market economy is not only an efficient use of local resources, but also improves women's status and economic security. The time allocation and decision making data reveal that women play the major role in agricultural production, both as laborers and managers. This suggests the need to train female agricultural extension agents and to make male workers aware of the need to reach female farmers. The results further indicate that involvement of women in the development process leads to lowered fertility and more positive attitudes toward educating female children. Tibeto-Burman women have lower birthrates than Hindu women, perhaps due to their greater economic security and availability of alternate female role models. An extensive methodological annex, including survey instruments, is included.
International Journal of Health Services. 1983; 13(4):649-60.In this review of Cheryl Payer's recent book, The World Bank: A Critical Analysis, the World Bank's role in the third world and the reasons why poverty, hunger, malnutrition, and unemployment are on the rise are discussed. The World Bank annually gives billions of dollars to third world governments, supposedly to develop their economies through a variety of loan projects. In reality, the loans subsidized the transnational corporations from the industrial countries and expand their industrial, commercial and financial activities in the third world. Capitalism has brought technological innovations, lowered infant mortality rates, and lengthened life expectancy in the third world. But it has also resulted in rapid population growth and an increase in other problems. Food, water, medical services, sanitary facilities and housing are becoming scarce to the poor. The World Bank has used its large resources, distributed annually on an increasing scale to its member countries, to expand capitalism in the third world and to fortify the business activities of the transnational corporations, including the large transnational banks. Many of the underdeveloped economies are having a difficult time due to an immense debt burden from all the lending activities of the World Bank. It is believed that the World Bank and capitalism will not be able to resolve the economic and social problems of the third world, and that socialism holds more hope for the masses worldwide. Under socialism, the World Bank would cease to exist. The World Bank and other UN agencies speak much, but really care nothing about problems facing the third world. It is believed that the growth of these problems are the prelude to the coming revolution that so frightens the World Bank and its supporters.
[Unpublished] 1983 Jul 29. 26 p. (UNFPA/CM/83/48; UNFPA/DR/83/39; UNFPA/RR/83/39; UNFPA/PA/83/9)This, the 5th report in a series prepared by the UN Fund for Population Activities (UNFPA) shows expenditures for population assistance by major donors in a historical series beginning 1971. Expenditure data for 1981 alone are given by recipient and major donors and by recipient and population sectors. The report also provides data on commitments, for the 1st time in the UNFPA series. In 1981 expenditures for population assistance came to US$491 million, an increase of US$15 million over the US$476 million level reached in 1980. In current terms, population assistance increased at the rate of almost US$20 million per annum from 1971-73. As in past years, the US made the largest contribution to population assistance in 1981. For the 1st time, Japan contributed the 2nd largest amount, with Norway and Sweden contributing a close third and fourth, and with the contribution of the Federal Republic of Germany in 5th place. Population assistance as a share of official development assistance for members of the Development Assistance Committee declined between 1977-80 from 1.74% to 1.29% and then rose slightly to 1.45% in 1981. From the recipients' perspective, there has been a steady, slow growth of funding by private organizations, a slight falling off of support by multilateral organizations, and an upswing in the size of bilateral assistance. Family planning continued to absorb the greatest share of population in 1981, when expenditures came to US$324 million or 66% of total population assistance of US$491 million. With the addition of assistance to communication and education programs, the share rose to 70%. In 1981, some US$37 million was provided for the collection of basic population data, US$29 million for demographic research and training, US$12 million for population policy formulation, US$13 million for policy implementation, US$21 million for communication and education programs, US$4 million for programs directed at special target groups, and US$51 million for multisector activities. The private organizations which led the way in promoting interest and awareness of population issues had, prior to 1975, contributed almost 1/4 of commitments to population assistance, and by the end of 1975 over US$1 billion had been committed to population assistance. In recent years, private funds have accounted for only 5% of population assistance as opposed to governments' 95%.
Social Science and Medicine. 1983; 17(19):1419-31.The Japanese level of health is one of the highest in the world, although the level is not uniform throughtout Japan. Preventive health care services are not integrated with medical care services. While efforts are being made in the health education subsystem of the primary health care services, organization is weak and funding and training of personnel are inadequate. Health specialists have failed to grasp the real meaning of primary health care, which includes the integration of services. Medical specialists also do not fully understand the idea of comprehensive primary health care. According to the Alma Ata Declaration, a conference sponsored by WHO and UNICEF in 1978, primary health care is to be responsive to sociocultural and political conditions and intimately tied to the development of other sectors of society. The recommendations of the Conference, to be achieved by 2000 are: 1) Primary health care must be linked with all other sectors of development; 2) Maldistribution of health services facilities and personnel must be overcome, so that care is truly accessible to all people; with the help of the community, disparities in health indices can be corrected; 3) Training and education is needed to develop a full understanding of primary health care among the politicians, the administrators, the opinion leaders and the public in general; 4) Training in health education should be a part of the basic training of health policy decision makers. Health education for the public should emphasize planning and organizational skills as well as more basic health education; 5) Training and education is needed to develop among medical specialists a respect for the work of allied health professionals, an awareness of the necessity of team work in primary health care, and a willingness to participate in team efforts; 6) Medical practitioners must help foster awareness of components of healthy living and encourage lay people to assume greater responsibility to the medical practitioners; 7) Paramount is the need for integration of medical care services and health care services at all levels. The Ministry of Health and Welfare has recently proposed special legislation which would integrate health activities and medical care for the aged. Tables and charts provide statistical summaries of mortality, causes of death, age structure projections, urban-rural residence, life expectancy, medical expenditures, clinical load for physicians, number of hospital beds, and staffing of health centers for Japan and selected comparisons to other Western Countries.
Community Development Journal. 1983; 18(2):104-19.A review of demographic trends and health and social problems in the fast growing urban areas of the world indicates that, in the future, increasing numbers of people will be living in precarious socioeconomic conditions which impede the achievement of health. It is estimated that from 4.4 billion in 1980 the world's population will increase to 6.2 billion by the year 2000. The urban population will increase from 1.8 to 3.2 billion during the same period, over 2 billion of which will be in developing countries. The rapid and often uncontrollable demographic growth of cities, especially in the developing world, stimulates the demand for resources, intensifies their utilization and creates an intolerable pressure on the urban infrastructure and physical environment. A number of action oriented projects to combat disease and contamination have been successful. Projects in Addis Ababa, Ethiopia, Colombo, Sri Lanka, Hyderabad, India, Guayaquil, Ecuador, Lima, Peru, and Rio de Janeiro have been implemented under a partnership among WHO, UNICEF, the Netherlands Aid Agency, the World Bank, and other international organizationals and governments. These projects all emphasize the fundamental role of community organizations, especially that of women; low-cost technology and the need to mobilize and efficiently use locally available resources; an ecological multisectoral concept of health whereby action concerning the environment, education, income generation and the availability of food, all with a powerful disease preventive potential, carry equal if not greater weight than the efforts to provide the population with health centers or implement curative practices. All these projects are focused on marginal groups; many were initiated by imaginative individuals or groups with a considerable amount of social orientation and motivation, and often, at least in the beginning, without the support of governments, nongovernmental or international organizations. It is important to study these projects in their accomplishments and failures; to help describe them and disseminate related information when appropriate; and to promote political and technical support for those which are successful so that they can rapidly come out of the experimental/demonstration phase and be expanded to become part of routine programs.
Grass roots, herbs, promoters and preventions: a reevaluation of contemporary international health care planning. The Bolivian case.
Social Science and Medicine. 1983; 17(17):1281-9.In evaluating a United States Agency for International Development (USAID) project in Bolivia, the author argues that the program unwittingly contributed to the situation that created Bolivia's political problems. A 5-year pilot project which covered 39 villages and colonies in the Montero district in the state of Santa Cruz began in 1975 and was completed in 1980. In 1980 the project was "deobligated" when all but essential economic aid to Bolivia was halted following a political coup. The pilot project was based on 1) community participation through health care; 2) a referral system from health post of the promotor to the center with an auxiliary nurse midwife, to secondary and tertiary care in hospitals by physicians; 3) an emphasis on preventive medicine; and 4) the use of traditional medicine along with other therapy by the promotor. Although these concepts sound appropriate, they are in fact derived from contemporary thought in advanced industrial societies. The assumptions about social reality that are inherent in these plans actually misconstrue Bolivian society. The unintended consequences of the project actually diminish rural health care. A difference between the Western health planner's conception and the Bolivian conception--of community, of effective referral systems, of preventive and indigenous medicines--can have the effect of producing a health care program that has little resemblance to what was originally intended. The Bolivian elite actually manipulated the USAID health care programs through hegemony in the villages. The Jeffersonian concept of community is not applicable in Bolivia where resources are only exchanged through personal contacts. In villages of multiple class or ethnic groups or both or in villages with close ties or histories of ties with larger, more cosmopolitan groups, multiple different interests exist. These work against each other to prevent the very cooperation envisioned by the health care programs. The author suggests that developed countries should consider native ideologies, native social relations, and indigenous medicine more sensitively in design.
London, England, International Institute of Communications, 1983 Aug. 28 p.Focus in this discussion is on government information services and what they do and could do in human settlement projects. It considers information use in and between government agencies, development support communications, participatory communications, and the mass media. Prior to reviewing information activities in human settlements, 5 concepts are examined: human settlements; government; information services; community participation; and project support communications. Schoenmakers, in a paper on government information as an instrument for human settlements policy, suggests 4 stages in the evolution of government information services. There are parallels in nutrition and family planning literature. In stage 1, information services to the public are ad hoc and unsystematic. Recognizing a public right to be informed, the government takes on an active role in stage 2. Government involvement becomes stronger in stage 3 as information is recognized as a fundamental instrument of policy implementation. In stage 4 the information service is involved in policy preparation and has a place in the top planning body. The review of the literature suggests that most programs are in one of the early stages of information use. Extensive literature on human settlements issues was found. Bibliographic references are found for information exchange systems and for community participation. Reports on information and communication activities are few. It is concluded that at least in the international literature, information services are not a high priority in human settlement patterns. World Bank financing for urban projects (defined as shelter, transport, integrated rural development, and regional development) is significant. By mid 1981 the Bank had approved 62 projects amounting to US$2 billion in lending commitments to 35 countries. The Lusaka Squatter Upgrading Project is the project most reported on in the literature in terms of information and communications. A good example, this project involves a local government agency, a project support unit for communications, intensive community involvement, and imaginative use of the media. Throughout the literature 2 themes continually emerge as representative of the root causes of failure in many housing programs: the failure of program planners to consider the needs, desires, preferences, and capabilities of the people who are envisioned as being served by the program; and the lack of interagency cooperation and coordination. Suggestions for improving communications in human settlements programs include: provide to planners adequate information on groups affected by the project; improve the quantity and quality of information flowing to the community; improve communications within and between agencies responsible for the planning and execution of the project; increase the flow of reporting on communications activities; encourage the use of simple research methods; simplify media choice; and strengthen the role of communications.
Washington, D.C., Battelle Human Affairs Research Centers, 1983 May. 62 p. (Contract: AID/DSPE-C-0076)1 of a series of Population and Development Policy Final Country Reports, this report on Jordan provides an account of the rationale, procedures, and outcomes for PDP activities. After reviewing country background (population characteristics and trends, development trends and characteristics, population policies, family planning service and information, research capabilities, and opportunities and needs for population policies, family planning service and information, research capabilities, and opportunities and needs for population assistance) and the PDP Program of Battelle Human Affairs Research Centers, research findings and dissemination activities are reported and follow-up activities are recommended. Jordan's population size is small--an estimated 3 million in 1980, but various other characteristics made it a priority for PDP assistance. In 1979 the annual rate of growth was estimated to be anywhere between 3.5-4.8%. Fertility surveys indicate that over half of married women in Jordan surviving through their childbearing years have at least 7 children. Battelle PDP's Core Project in Jordan was designed to encourage the formulation of population policy. The project, titled Major Issues in Jordanian Development, was coordinated by the Queen Alia Welfare Fund. The project ran from July 1981 to April 1983 and encompassed 2 major types of activities: 6 2-person teams of researchers and government program managers collected and analyzed existing information on population and development issues, and 4 of the 6 research review papers prepared under the project directly addressed development issues of interest to the government i.e., education and training of women, social defense, income distribution, and demand for health services; and dissemination of the findings of the research review and analysis projects to national decision makers and opinion leaders in Jordan. The 6 research reviews were undertaken by pairs of authors, most of which included 1 government representative and 1 private or university researcher. Close monitoring and extensive technical assistance was provided to this project through several field visits and frequent correspondence. Brief descriptions are included of the 6 major issue papers. The paper on demographic trends in national planning reviews the literature on determinants of fertility and the effects of population growth and provides a historical analysis of the role of population variables in Jordan's past development plans. In the paper devoted to the education and training of women, women's schooling was found to be the most robust determinant of married women's fertility in the 1972 and 1976 Jordanian Fertility Surveys. The paper dealing with poverty and its implications for development reviews the extant data on per capita and poverty line data. The team that analyzed the demand for medical services proposed a regional plan for community-based health services. The topics of the final 2 papers were consequences of rapid population growth on development and social defense.